Q&A with Adaira Landry, MD, MEd, Harvard Emergency Medicine Assistant Residency Director

Adaira Landry, MD, MEd, is the Assistant Residency Director for the Harvard Emergency Medicine Residency.  She went to UC Berkley where she earned degrees in Molecular Cell Biology and African American Studies. After a gap year for work and research, she attended UCLA for medical school. Dr. Landry completed her emergency medicine residency at NYU where she served as chief resident her final year. She completed an Ultrasound Fellowship at Brigham and Women’s Hospital and earned her MEd with a focus on Technology, Innovation and Education at the Harvard Graduate School of Education. She is interested in digital innovation, resident wellness, and increasing diversity and inclusion in medicine.

Tell us about yourself.

I was born in California and I went to an understated, second generation Dutch high school, and there were only about 300 students. I was only 12 years old when I started high school; I was pretty shy initially but I decided early to get involved in academic opportunities. I was the first African American and also the youngest student body president of my high school. From there I went to Berkeley which was about 40,000 people. It was a huge change, and I felt a difference in my value in a way; I was just this small drop in this huge ocean of overachievers. I studied Molecular Cell Biology and African American Studies. It wasn’t easy for me to confirm that I wanted to go to medical school—I debated the cost, my grades, my interests. I took a year and did some research, applied to medical school, and had some odd jobs. From there, I went to UCLA and did my med school for four years there. I did two years of HIV research while I was in med school and decided at the end of my second year that I don’t actually want to do bench research. I loved the variety of patients I saw on my ED rotation, so I applied into emergency medicine. From there, I went to NYU for four years and [then] to Boston to get a master’s at the Harvard School of Education. That master’s was really focused on technology, innovation, and education. A lot of my classes were on how to create a start ups, or how to create a product for education; it was very innovative. At the same time I was doing my master’s I was also doing a fellowship in ultrasound. For those two years I was very busy, because I was also working clinically. And then after I finished up my master’s while I was finishing my ultrasound fellowship, I delivered my first baby, which was really fun. In July of [2017] I was hired on full-time at Brigham and Women’s Hospital to be the Assistant Residency Director for the Department of Emergency Medicine and the Director of Residency Ultrasound Education.

When did you first decide to become a physician? Why?

I’m definitely the first doctor in my extended family on both sides. My mom was a tech at a psychiatric hospital when I was growing up, and she eventually went back to school to become a nurse. She always told me that she wanted me to be a doctor. I actually wanted to be a judge when I was little, and I would rebel. She would say “You’re going to be a doctor” and I would say “No, I’m going to be a judge!” When I entered Berkeley, I ended up declaring premed, but I wasn’t quite sure in the beginning whether not I wanted to do premed or law. 

What actually happened was I was on my way to class one day and there was this crowd of people on the corner of the street. I could see everyone looking worried, and I could see these two feet on the ground peering out, and so I thought someone must be sick. I ran over there, and he was diaphoretic (sweating), and he didn’t look well. I didn’t know what was going on at the time, but I saw this small little bracelet on his wrist, and I saw that everyone looked a bit confused, so I sort of “took charge”. I asked someone to call 911… and then I looked at his bracelet. I flipped it over and saw that he was diabetic. I knew that diabetes had something to do with your sugar levels, but I wasn’t sure if he needed sugar or if he had too much on board. It was that knowledge gap that made me feel like I want to be able to not be confused in these situations. I want to make a judgment call and feel like I had something behind it. So I ended up just sitting there holding his hand until EMS got there. 

I was on my way to my first day of class so I didn’t recognize him. It turned out he was actually in the same class and later recognized me. I showed up to class a week later and there was a huge bouquet of flowers and a note from him that said thank you so much for just being there. I felt like I did nothing, but it kind of spoke to me—the small things you do, the little bitty small things, the cumulative things you do in medicine really add up to potentially change someone’s life.

How did you choose the medical school you attended?

It was actually not my top choice… I wanted to go to school on the East Coast, and I got waitlisted at one of my top schools. I had already taken a year off, and I was very honored to be offered the opportunity to go to UCLA… It was my #2, and that was based off of school location, price, and their focus on treating underserved populations. Those are the things I really loved about training there. I’m actually very grateful that I had the opportunity because I think it led me to the path where I’m at now. 

What was the biggest challenge you faced in medical school?

I felt pretty lost in med school. I had a really hard time with a couple of things. The first was mentorship. I didn’t know what it meant to be a mentee, and because of that I had not-so-great relationships with mentors. Without that, it’s really hard to get to your goal if there’s not much as far as guidance and someone pointing you in the direction of your next step. I felt that because I didn’t know how to seek mentorship in the beginning, I got a late start. It wasn’t until my 3rd and 4th year that I got a little bit better, but that was one hard thing, the mentorship.

The second thing was for me swallowing all of the content and filtering out what was necessary and what extraneous. That took me about a year to realize what is and what isn’t helpful.

So how do you go about being a good mentee?

You have to realize that you can have more than one mentor; you can really break down your mentorship into a “personal board of directors”, which is basically a panel of people who serve different purposes for you. You can have a mentor who helps you with your personal life, you can have a mentor who helps you with clinical medicine, a mentor for studying, a mentor for financial advice, a religious mentor. That was a foreign concept to me at the time. I felt like I needed to find someone who met all of these needs, and I didn’t know where to start. If I had to tell myself something, it would be find someone you value and figure out why you value that person… and try to nurture the relationship in a way where every time you meet with that person about this particular topic, you bring something to the conversation.… If you just show up and expect someone to hand you opportunities, you will fall short on opportunities.

Why did you decide to specialize in emergency medicine?

I love controlled chaos where I know things are all over the place, but with good leadership skills and good clinical knowledge, with good bedside manner, with a good team, you can take control and reign it all in. I wanted to go into a place where I had no clue what I was going to face. You’re in a situation where someone will say “Oh thank God, this person is here to help.” I love that rescue attitude and that need to really be in the moment where you can potentially save the day. And a lot of emergency is not saving the day; a lot of emergency medicine is reassurance. But to have that skillset is very powerful, I think.

As chief resident of your EM program, you did some work on wellness for residents. What did that look like? What advice do you have for residents struggling to take care of both themselves and their patients?

As a 3rd year resident I got a [$5000] grant… to create something innovative. One thing I noticed was there was a lot of untreated stress and burnout in the premedical and medical professions where people feel a lot of internal more than even external pressure to be excellent and to not make mistakes. I think because of our high expectation to do well, when you get into residency and you’re expected to manage your emotions, manage your mistakes, manage the requirements to learn on shift and off shift; all these expectations can lead you to the point where you start to feel exhausted emotionally. You start to feel separated from your work. I felt that in myself and I felt that in a lot of my co-residents… so I wanted to start something that addressed the problem. I started something called Project SafeSpace. It’s a downstream solution because it’s there to solve the effects of the problem. I hired psychiatrists to come into my residency and do group therapy for each class. It was mandatory in the sense that if you were at conference you had to go, but we didn’t force anyone to participate.

How did you balance having a baby with your work and education? What advice do you have for women who want to start a family while in medical training?

It’s so hard because you feel like your life passion before you become a parent is to help treat others, and then [when you have a child] that still remains your passion, but your priorities changes a lot. To manage both requires frequent check-ins with yourself and with your partner to see how they are feeling. It’s very easy to continue to pick up projects and continue to try to progress yourself and not notice how other people are feeling. I try to do frequent check-ins with my husband. If an opportunity comes up I say “what do you think about this? Do *we* have the bandwidth?” I want it to be cooperative. The way I pick an opportunity at this point, especially with a child, is I will say yes to a project if it gives me an opportunity to work with someone amazing or it gives me an opportunity to work on something amazing. I don’t necessarily need both, but I absolutely need one of those two to be true.

What advice do you have for students coming from a minority background who want to pursue a medical career?

I would say look at the numbers. The number of persons who are like you at your institution in high school, institution in college, institution in medical school, and use that as a form of encouragement if they are not what you think they should be. Because without your determination, without your motivation to move the needle, the numbers are not going to improve. So you have to know quantitatively where your value is and why it’s so important for a patient, for a nurse, for a tech, for your colleagues to see your face when you show up to work. They need to hear your accent, to see your disability, to understand your religion; you just have to be there for someone to understand it.

From your perspective, what is the biggest problem in healthcare today?

My biggest motivation is that we have a changing patient population [that is] getting more diverse and we [as physicians] are not matching that. I think it’s very important when our patients come to us that they feel comfortable with who is treating them. And I think the biggest problem is that that need is not met. So while there are other financial problems, there are problems with insurance, while there are problems with immigration—there’s a ton of political stuff, for me on a personal level, this is it, this is a big problem. And that’s why I started MIX.

Tell me about MIX—What is it and what is your goal for the project?

I started MIX because I wanted to have a provider, any provider, be able to walk into a room, and there is no doubt of their capability to provide care based on their phenotype, based off of what they look like. We are so far from there. I created MIX, which stands for Minority Inclusion and eXposure as the first step in this very long process to try to change what I call the face of medicine, the face of healthcare, such that it is commonplace to see someone with large curly hair, or dreadlocks, or someone in a wheelchair, or someone with a prominent Mexican accent, you won’t even notice it because it’s so commonplace. MIX is all about storytelling, telling the stories of people who have felt that when they walk into a room, someone would… signify something that made the provider feel like they might not be trusted or they might not be welcome.

So how do you solve that?

I think a lot of it is with inclusion and exposure, so MIX is going to be a large project, but the first part of it is the Instagram account, @joinmix. On the Instagram account, I interview people of various backgrounds and I have them tell me their stories. Such that if another minority provider is watching it, they can say, “Wow, she looks like me and she was able to do it.” 

What should students know before starting their EM clinical rotation to help them be successful?

There are three things I would consider when it comes to doing well on your rotation: The first—this is the biggest filter—people just want to know, are you someone that I can have a conversation with? Are you someone who I can engage with and do you understand social cues? Because you can be so brilliant, but if someone can’t have an interview with you, can’t take a presentation from you, it just blocks you out. You have to know yourself, you have to get feedback from someone. Find that mentor or find someone to practice interviewing with you and give you feedback on that.

The second thing is your level of initiative and how motivated you are to be there. I don’t care if you hate emergency medicine, you show up to work. Never say things like, “well I’ve already seen two of these patients, I don’t really want to see the next patient.” Everything comes back to a learning opportunity; everything is an opportunity for you to do well. Obviously the caveat is don’t burn out, don’t overwork yourself, but there should be some level of balance. 

The third thing is your clinical aptitude. Obviously understanding a clinical scenario and demonstrating that you’ve learned some things in medical school [is important]… If you have a patent, for instance, who has a presentation that you have absolutely no clue what the diagnosis is, you can still shine in that presentation by demonstrating your interest in learning. So for instance, if you have a patient who comes in on a particular medication you’ve never heard of, you would end the presentation with a clinical question. You would say, “I’ve never heard of Coumadin, I don’t really know how that works. The thing I want to learn about this patient is how Coumadin works, and I would like to come back and talk to you about that at some point in time.” That shows me, “wow, this person is really interested in learning.”

And remember to be yourself. That’s kind of contradictory to a lot of [advice], but we’re not asking you to fit a mold as much as we’re asking you to have insight. And to be able to self-reflect.